College of Pharmacy and Pharmaceutical Sciences, Florida Agricultural and Mechanical University, Tallahassee, Florida, USA.
Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA.
Clin Cardiol. 2020 Oct;43(10):1076-1083. doi: 10.1002/clc.23431. Epub 2020 Aug 11.
Heart disease continues to be the leading cause of death in the United States, with approximately 805 000 cumulative deaths from myocardial infarctions (MI) from 2005 to 2014. Gender and racial/ethnic disparities in MI diagnoses are becoming more evident in quality review audits. Although recent changes in diagnostic codes provided an improved framework, clinically distinguishing types of MI remains a challenge. MI misdiagnoses and health disparities contribute to adverse outcomes in cardiac medicine. We conducted a literature review of relevant biomedical sources related to the classification of MI and disparities in cardiovascular care and outcomes. From the studies analyzed, African Americans and women have higher rates of mortality from MI, are more probably to be younger and present with other comorbidities and are less probably to receive novel therapies with respect to type of MI. As high-sensitivity troponin assays are adopted in the United States, implementation should account for how race and sex differences have been demonstrated in the reference range and diagnostic threshold of the newer assays. More research is needed to assess how the complexity of health disparities contributes to adverse cardiovascular outcomes. Creating dedicated medical quality teams (physicians, nurses, clinical documentation improvement specialists, and medical coders) and incorporating a plan-do-check-adjust quality improvement model are strategies that could potentially help better define and diagnose MI, reduce financial burdens due to MI misdiagnoses, reduce cardiovascular-related health disparities, and ultimately improve and save lives.
心脏病仍然是美国的主要死因，从 2005 年到 2014 年，大约有 805000 人因心肌梗死（MI）而死亡。在质量审查审计中，MI 诊断的性别和种族/民族差异变得更加明显。尽管最近诊断代码的变化提供了一个改进的框架，但临床上区分 MI 的类型仍然是一个挑战。MI 的误诊和健康差异导致心脏医学的不良后果。我们对与 MI 分类和心血管保健及结果差异相关的生物医学相关文献进行了综述。从分析的研究中可以看出，非裔美国人和女性的 MI 死亡率更高，更可能年轻，且伴有其他合并症，并且在 MI 类型方面不太可能接受新的治疗方法。随着高敏肌钙蛋白检测在美国的应用，实施时应考虑到种族和性别差异在参考范围和新检测诊断阈值中的表现。需要进一步研究来评估健康差异的复杂性如何导致不良心血管结局。创建专门的医疗质量团队（医生、护士、临床文档改进专家和医疗编码员）并采用计划-执行-检查-调整质量改进模型是潜在的策略，可以帮助更好地定义和诊断 MI，减少因 MI 误诊造成的财务负担，减少心血管相关的健康差异，并最终改善和拯救生命。
